Provider Demographics
NPI:1760580336
Name:PREMIERE PHYSICIANS P.A.
Entity Type:Organization
Organization Name:PREMIERE PHYSICIANS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-366-0550
Mailing Address - Street 1:314 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-366-0550
Mailing Address - Fax:302-366-8905
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-366-0550
Practice Address - Fax:302-366-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024589Medicaid
DE1000024589Medicaid